Provider Demographics
NPI:1720352834
Name:GRAVELY, JULIE MARIE (COTA/L)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:MARIE
Last Name:GRAVELY
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 STANSBURY LN
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27527-3908
Mailing Address - Country:US
Mailing Address - Phone:919-553-4105
Mailing Address - Fax:
Practice Address - Street 1:200 STANSBURY LN
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27527-3908
Practice Address - Country:US
Practice Address - Phone:919-553-4105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-07
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1353224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant